Outcomes of patients with spontaneous coronary artery dissection

Abstract

BackgroundSpontaneous coronary artery dissection (SCAD) is an uncommon but serious condition presenting as an acute coronary syndrome (ACS) or cardiac arrest. The pathophysiology and outcomes are poorly understood. We investigated the characteristics and outcomes of patients presenting with SCAD.MethodsIn a retrospective study of a large cohort of patients with SCAD, data were collected regarding clinical presentation, patient characteristics, vascular screening, coronary artery involvement and clinical outcomes.Results40 patients with SCAD (95% women, mean age 45±10 years) were included. At least 1 traditional cardiovascular risk factor was present in 40% of patients. Migraine was reported in 43% of patients. Events preceding SCAD included parturition (8%), physical stress (13%), emotional stress (10%) and vasoconstrictor substance-use (8%). 65% of patients had a non-ST elevation ACS (NSTEACS) at presentation, 30% had an ST elevation myocardial infarction (STEMI) and 13% had a cardiac arrest. The left anterior descending artery was most frequently involved (68% of patients), and 13% had involvement of multiple coronary territories. Fibromuscular dysplasia (FMD) was identified in 7 (37%) of 19 patients screened. 68% of patients were managed medically, 30% had percutaneous coronary intervention and 5% had coronary artery bypass grafting. Over a median 16-month follow-up period, 8% of patients had at least 1 recurrent SCAD event. There were no deaths.ConclusionsPatients with SCAD in this study often had multiple coronary territories involved (13%) and extracardiac vascular abnormalities, suggesting a systemic vascular process, which may explain the high incidence of migraine. All patients with SCAD should be screened for FMD and followed closely due to the possibility of recurrence.

Spontaneous Coronary Artery Dissection and Its Association With Fibromuscular Dysplasia and Other Vascular Abnormalities

“…Recurrent SCAD is common and affects 8% to 27% of patients with recurrent events occurring days to years later. 11,12,18,19 During a median follow-up of 1.7 years, we found that 6% of patients suffered recurrent SCAD, ranging between 7 days and 3.6 years later. Recent data have shown that hypertension predicts recurrent SCAD whereas beta-blockade may reduce this risk.…”

Chronic spontaneous coronary artery dissection in association with antiphospholipid syndrome presenting as stable angina

“…SCAD is a condition which predominantly occurs in women with reports of over 90% of patients being women 11 13–15. A prospective study reported the average age of men with SCAD to be 48.6±9.8 years which was less than women at 52.3±9.2 years 16.…”

“…There are few case reports on SCAD in association with systemic inflammatory disease but even fewer with antiphospholipid antibody or antiphospholipid syndrome 3–9. SCAD almost always presents as ACS with elevated cardiac troponin and it predominantly occurs in women with reports of over 90% of patients being women 10–15. We present a rare case of a male patient who had chronic SCAD of the right coronary artery (RCA) which presented as stable angina in association with a known diagnosis of antiphospholipid syndrome.…”

Spontaneous coronary artery dissection: contemporary aspects of diagnosis and patient management

“…This entity predominantly affects female gender, which represent 81%–100% (weighed average 91.6%). Mean age ranges from 45 to 56 (weighed average 50+/-9.8) years presenting normal distributions within series, where cases <30 or >80 years are rare 1–4 6–9 11. Caucasian or white race is reported in US and Canadian series as much as 76%–82% of the patients,2 9 though this is likely influenced by local demographics and referral bias.…”

“…Spontaneous coronary artery dissection (SCAD) is an important non-atherosclerotic aetiology underlying acute coronary syndromes (ACS) or sudden cardiac death in young and middle-age women. Knowledge of the pathophysiology, diagnosis and management of SCAD has exponentially increased over the last years,1–12 leading to more awareness and enhanced recognition by cardiologists worldwide. This also explains the creation of dedicated working groups,13 14 alongside with e-platforms intended to gather patients with SCAD, and get them involved in research projects 15.…”